Family functioning as a mediator between neighborhood conditions and children's health: evidence from a national survey in the United States.

This study examines whether the associations between neighborhood conditions and children's health can be indirect and operate through aspects of family functioning. We use data from the 2007 National Survey of Children's Health in the United States with the interviewed parents/guardians as the only source of the data. Our study sample includes 53,023 children aged between 6 and 17 years. Using structural equation modeling, we test both direct and indirect relationships between a family functioning index, a general indicator of children's health status, and three neighborhood factors: neighborhood physical resources, environmental threats, and collective efficacy. Covariates in the analysis include gender, age, income, race, family structure, parental education, and health insurance coverage. All the three neighborhood factors show direct associations with children's general health status, as well as indirect associations mediated by aspects of family functioning. Among the three neighborhood factors, collective efficacy and environmental threats are found to have much stronger associations with children's general health than physical resources. When designing health-promoting neighborhoods for children and families, it may be more efficient for urban planners and health professionals to focus on community programs that reduce environmental stressors and foster neighborhood cohesion than programs that solely improve physical infrastructure. This study also verifies that aspects of family functioning mediate the associations between neighborhood conditions and children's health. It is recommended that both family and neighborhood are critical points for child health intervention.